Provider Demographics
NPI:1992714950
Name:DEEPA INC
Entity type:Organization
Organization Name:DEEPA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KETAN
Authorized Official - Middle Name:ARVIND
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-833-3930
Mailing Address - Street 1:11813 1/2 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136
Mailing Address - Country:US
Mailing Address - Phone:410-833-3930
Mailing Address - Fax:410-526-0175
Practice Address - Street 1:11813 1/2 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136
Practice Address - Country:US
Practice Address - Phone:410-833-3930
Practice Address - Fax:410-526-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP016863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2118176OtherNCPDP #
MDBT7409217OtherDEA #
MD5433360001Medicare NSC